Efficacy of a Three-day Prolonged-course of Multiple-dose Versus a Single-dose of Tranexamic Acid in Total Hip and Knee Arthroplasty

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2020 May 2

PMID 32355751

Citations 11

Authors

Xiang-Dong Wu

Mian Tian

Yao He

Yu Chen

Yu-Zhang Tao

Long Shao

Changqi Luo

Peng-Cheng Xiao

Zheng-Lin Zhu

Jia-Cheng Liu

Wei Huang

Gui-Xing Qiu

Affiliations

Soon will be listed here.

Abstract

Background: The application of tranexamic acid (TXA) in total hip arthroplasty (THA) and total knee arthroplasty (TKA) has brought momentous changes in blood management. However, the optimal regimen of TXA has not yet been identified. This study aimed to compare the efficacy of a three-day prolonged-course of multiple-dose of TXA with a single pre-operative dose of TXA in patients who undergo THA and TKA.

Method: We retrospectively analyzed two groups of consecutive patients who received primary unilateral THA and TKA from 2015 to 2017. One group received a three-day prolonged-course of multiple-dose of TXA, while another group received a single-dose of TXA. The primary outcomes included the changes in hemoglobin (Hb), estimated total blood loss (TBL), and transfusion rate; the secondary outcomes included the platelet (PLT) counts, inflammatory markers, and fibrinolysis parameters.

Results: A total of 193 THA and 166 TKA procedures were included for comparison. Compared with the patients who received a single-dose of TXA, the patients who received a three-day prolonged-course of multiple-dose of TXA had smaller post-operative drops in Hb levels, which led to consistently significantly higher Hb levels in both THA and TKA. Therefore, the use of multiple-dose of TXA was associated with significantly lower maximum Hb drops and estimated TBL in both THA (24.58±11.43 30.38±11.33 g/L, P=0.001; 685.88±412.02 968.94±479.9 mL, P<0.0001) and TKA (18.04±9.75 27.24±10.99 g/L, P<0.0001; 497.35±291.03 816.51±354.38 mL, P<0.0001), and marginally reduced transfusion requirements (THA: 1/65 10/128; TKA: 0/70 2/96). The multiple-dose group also showed higher PLT counts, continuously reduced inflammatory responses, and significantly and durably attenuated fibrinolytic responses.

Conclusions: A three-day prolonged-course of multiple-dose of TXA was consistently effective in reducing post-operative Hb drops, estimated TBL, inflammatory responses, and fibrinolytic responses, which could be recommended for clinical practice. However, these findings need to be confirmed by prospective studies.

Citing Articles

Incidence of Subclinical Deep Vein Thrombosis after Total Hip and Knee Arthroplasty Is Not Correlated with Number of Tranexamic Acid Doses.

Bocea B, Catrina B, Roman M, Ion N, Fleaca S, Mohor C J Clin Med. 2024; 13(13).

PMID: 38999401 PMC: 11242633. DOI: 10.3390/jcm13133834.

[Efficacy and safety of multiple-dose intravenous tranexamic acid for reducing blood loss in complex tibial plateau fractures: A prospective randomized controlled trial].

Bao W, Zhou J, Wang Y, Wang J, Chu M Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023; 37(9):1055-1061.

PMID: 37718415 PMC: 10505624. DOI: 10.7507/1002-1892.202305026.

Complications and hospitalization costs in patients with hypothyroidism following total hip arthroplasty.

Huang Y, Huang Y, Chen Y, Yang Q, Yin B J Orthop Surg Res. 2023; 18(1):567.

PMID: 37537620 PMC: 10401868. DOI: 10.1186/s13018-023-04057-0.

Total Hip Arthroplasty Patients with Distinct Postoperative Fibrinolytic Phenotypes Require Different Antifibrinolytic Strategies.

Liu J, Chen B, Wu X, Wang H, Zuo X, Lei Y J Clin Med. 2022; 11(23).

PMID: 36498472 PMC: 9736050. DOI: 10.3390/jcm11236897.

Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: A retrospective comparative cohort study.

Turan K, Muratoglu O, Ergun T, Cabuk H, Erturer R Medicine (Baltimore). 2022; 101(38):e30823.

PMID: 36197255 PMC: 9509162. DOI: 10.1097/MD.0000000000030823.

References

Fillingham Y, Ramkumar D, Jevsevar D, Yates A, Shores P, Mullen K . The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis. J Arthroplasty. 2018; 33(10):3070-3082.e1. DOI: 10.1016/j.arth.2018.03.031. View

Montroy J, Hutton B, Moodley P, Fergusson N, Cheng W, Tinmouth A . The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. Transfus Med Rev. 2018; . DOI: 10.1016/j.tmrv.2018.02.003. View

Yuan X, Li B, Wang Q, Zhang X . Comparison of 3 Routes of Administration of Tranexamic Acid on Primary Unilateral Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplasty. 2017; 32(9):2738-2743. DOI: 10.1016/j.arth.2017.03.059. View

Wu X, Hu K, Sun Y, Chen Y, Huang W . Letter to the Editor on "The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis". J Arthroplasty. 2018; 33(10):3365-3368.e1. DOI: 10.1016/j.arth.2018.05.028. View

Shin Y, Yoon J, Lee H, Park S, Lee D . Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016; 25(11):3585-3595. DOI: 10.1007/s00167-016-4235-6. View

Gu W, Gu X, Wu X, Chen H, Kwong J, Zhou L . Restrictive Versus Liberal Strategy for Red Blood-Cell Transfusion: A Systematic Review and Meta-Analysis in Orthopaedic Patients. J Bone Joint Surg Am. 2018; 100(8):686-695. DOI: 10.2106/JBJS.17.00375. View

Sehat K, Evans R, Newman J . Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2004; 86(4):561-5. View

Fillingham Y, Ramkumar D, Jevsevar D, Yates A, Bini S, Clarke H . Tranexamic Acid Use in Total Joint Arthroplasty: The Clinical Practice Guidelines Endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip.... J Arthroplasty. 2018; 33(10):3065-3069. DOI: 10.1016/j.arth.2018.08.002. View

Wu X, Chen Y, Tian M, He Y, Tao Y, Xu W . Application of thrombelastography (TEG) for safety evaluation of tranexamic acid in primary total joint arthroplasty. J Orthop Surg Res. 2019; 14(1):214. PMC: 6631762. DOI: 10.1186/s13018-019-1250-6. View

10.

Blanie A, Bellamy L, Rhayem Y, Flaujac C, Samama C, Fontenay M . Duration of postoperative fibrinolysis after total hip or knee replacement: a laboratory follow-up study. Thromb Res. 2012; 131(1):e6-e11. DOI: 10.1016/j.thromres.2012.11.006. View

11.

Foley J, Conway E . Cross Talk Pathways Between Coagulation and Inflammation. Circ Res. 2016; 118(9):1392-408. DOI: 10.1161/CIRCRESAHA.116.306853. View

12.

Xie J, Hu Q, Ma J, Huang Q, Pei F . Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial. Bone Joint J. 2017; 99-B(11):1442-1449. DOI: 10.1302/0301-620X.99B11.BJJ-2017-0488.R1. View

13.

Gross J . Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983; 58(3):277-80. DOI: 10.1097/00000542-198303000-00016. View

14.

Tan J, Chen H, Liu Q, Chen C, Huang W . A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res. 2013; 184(2):880-7. DOI: 10.1016/j.jss.2013.03.099. View

15.

Magill P, Cunningham E, Hill J, Beverland D . Identifying the period of greatest blood loss after lower limb arthroplasty. Arthroplast Today. 2018; 4(4):499-504. PMC: 6288045. DOI: 10.1016/j.artd.2018.09.002. View

16.

Wu X, Jiang F, Xiang B, Huang W . Letter to the Editor on "Routine Postoperative Laboratory Tests Are Not Necessary After Primary Total Hip Arthroplasty". J Arthroplasty. 2019; 34(5):1043-1045. DOI: 10.1016/j.arth.2019.01.024. View

17.

Yazdi H, Klement M, Hammad M, Inoue D, Xu C, Goswami K . Tranexamic Acid Is Associated With Reduced Periprosthetic Joint Infection After Primary Total Joint Arthroplasty. J Arthroplasty. 2019; 35(3):840-844. DOI: 10.1016/j.arth.2019.10.029. View

18.

Wu Y, Zeng Y, Shen B, Si H, Cao F, Yang T . Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial. Hip Int. 2016; 26(4):331-7. DOI: 10.5301/hipint.5000356. View

19.

Ma J, Huang Z, Shen B, Pei F . Blood management of staged bilateral total knee arthroplasty in a single hospitalization period. J Orthop Surg Res. 2014; 9:116. PMC: 4232703. DOI: 10.1186/s13018-014-0116-1. View

20.

Fillingham Y, Ramkumar D, Jevsevar D, Yates A, Shores P, Mullen K . The Efficacy of Tranexamic Acid in Total Hip Arthroplasty: A Network Meta-analysis. J Arthroplasty. 2018; 33(10):3083-3089.e4. DOI: 10.1016/j.arth.2018.06.023. View